This is a very common question among bodybuilders thinking of doing steroids. It also is a concern for middle aged men thinking of trying testosterone supplementation (Hormone replacement therapy). You may have read about some links between prostate cancer and steroids/HRT therapy. Is it really fact or is it just based on far reaching assumptions?
Steroids and prostate growth (BPH)
Before we discuss steroids and it’s role on prostate cancer, first we must discuss steroids’ possible actions on prostate growth (BPH). The prostate first grows during puberty. Then around 25, the prostate starts to grow again in a 2nd phase. The 2nd phase eventually may lead to prostate enlargement years down the road. Half the men in their 60’s will have significant prostate enlargement.
Steroids(including normal testosterone in the body) stimulate the androgen receptors in the prostate. Excessive levels of androgenic steroids (such as through steroid use) causes prostate growth/enlargement called BPH (Benign prostate hyperplasia) in a short period of time. Once excessive system levels of androgenic steroids drops, than the prostate will start to shrink back again. It may not shrink completely back to it’s former size however.
In non-steroid users, testosterone mainly causes it once it converts to DHT. DHT is much more androgenic(binds to the receptors stronger) than testosterone. The drug finasteride is prescribed to help alleviate prostate growth. It works by blocking the conversion of testosterone to DHT. Steroid users will often use finasteride, in order to block the effects of hair loss and prostate growth while on cycle.
BPH caused by Testosterone or Estrogen?
In non-steroid users, older men are afflicted with BPH. This seems backwards, since BPH is supposed to be correlated with high androgens right? We know that older men have lower testosterone(and DHT) levels, so how is this possible?
Well there is 3 basic theories on what causes BPH for non-steroid users. No one yet seems to know for certain which theory is correct.
Theory 1 - Excessive estrogen levels. Older men have a higher estrogen and lower testosterone levels. According to research, the use of anti-estrogens are well documented to help shrink the prostate. The famous steroid research chemist Patrick Arnold, has claimed that there is more evidence pointing to a high estrogen to low testosterone being the cause of BPH.
Theory 2 - Despite the lowering testosterone levels( and hence DHT) levels in older men, research suggests men still probably accumulate high levels of DHT in the prostate. This would explain why people why older men can still get BPH despite declining levels of testosterone and DHT in the body. Another fact to help support this theory, is that Men who don’t produce DHT naturally due to genetic defect, also don’t develop BPH.
Theory 3 – Genetic Programmed growth. The fact that prostate cells awaken again in the mid 20’s to re-grow suggests that maybe BPH growth is programmed genetically. By the time men are in their 90’s, 90% will suffer from BPH.
Other interesting study results: In one study, when estrogen and dht were both reduced with hormonal blockers, the prostate gland actually increased in size. This is startling since if one of these hormones is to play a role in BPH, why when reducing both, did it cause prostate growth?
What causes prostate cancer?
First we must realize BPH and prostate cancer are not the same thing. BPH is a condition of excessive growth of the prostate. They do not know currently, if BPH is a pre-cursor condition to prostate cancer. Prostate cancer is actually a very common occurence in men, much more than the public is aware. It is said that most men would die of prostate cancer, if they didn’t die of something before that. Prostate cancer is usually very slow growing. Many elderly men live decades with prostate cancer and may not even know they have it.
The truth is, no one really knows what leads exactly to prostate cancer. There is a lot of conflicting data. In fact, if you look at many studies out there, most don’t even show a link between prostate cancer and higher testosterone levels. Yet, many doctors seem to believe it does. Some recent studies have shown that there was no increased risk of prostate cancer based on testosterone levels. Many doctors who put middle aged men on testosterone replacement therapy, have not seen a higher incidence of prostate cancer developing. Doctors are also usually worried about BPH from testosterone, but men have actually had a reduction in their BPH from using testosterone hormone replacement therapy to treat low testosterone.
The fear of prostate cancer by doctors, is one reason why doctors are often hesitant to do HRT(hormone replacement therapy). HRT therapy is for older men and others deficient in testosterone, to bring them up to healthy levels. The January 2004 New England Journal of Medicine (NEJM) wrote that testosterone does not cause prostate cancer, but they need to be monitored, since it may stimulate hidden prostate cancer. What do they mean by hidden prostate cancers? Apparently in about half the men over age 50, they may have prostate cancer, but it is asymptomatic. In other words, it is not growing and causing harm. If they were to supplement with testosterone, according to them, it may possibly stimulate these harbored cancer cells into a aggressive form of prostate cancer. That is why doctors will check for PSA(prostae specific antigen), BPH, and have more frequent prostate exams when starting HRT therapy. PSA is a very accurate marker of existing cancer and when it goes back to zero it means the person has been cured. Testosterone therapy could “awaken” these sleeper cancer cells. This is what they theorize, yet there is no scientific research to show that this is really what happens.
What we do know, is that there is many factors that might increase the risk of prostate cancer.
1) Increased ejaculation in your 20’s. This may sound awkward, but there were some studies that recently came out with this result. They found that those who ejaculated a lot more frequently in their 20’s, had less likely occurence of prostate cancer. The prostate gland is known to hold a much higher concentration of the bodies’ toxins. The researchers believed that ejaculation may lead to “cleansing” the prostate from carcinogens (cancer causing toxins).
2) Genetics & Heredity – Prostate cancer also seems to run at a higher rate in families with a pre-disposition to it. There is currently research looking at various enzymes and prostate genes, that may be involved in developing the cancer. African americans also have a higher incidence of prostate cancer.
3) Diet/Environment – Diets high in animal fat increase incidence of prostate cancer. Men who moved from Japan where prostate cancer incidence is lower, had increased risk in their sons and grandsons when living in the U.S. Therefore, diet and other environmental factors seem to increase risk of prostate cancer.
Prostate cancer is caused by a variety of risk factors. Experts seem to continue to try and make this link between high testosterone levels (or other steroids) and prostate cancer, yet there is no real solid research proof that testosterone levels is the direct cause. There is a growing body of research showing there is no link and that it may be caused by other factors. If Testosterone and steroids caused prostate cancer, a lot of men at a young age would probably be getting prostate cancer.